Citation Nr: 21016157 Decision Date: 03/20/21 Archive Date: 03/20/21 DOCKET NO. 16-58 152 DATE: March 20, 2021 ORDER New and material evidence having been received, the claim of service connection for a psychiatric disorder is reopened; service connection for schizophrenia is granted. New and material evidence having been received, the claim of service connection for a bilateral eye disorder is reopened; to this limited extent, the appeal is granted. New and material evidence having been received, the claim of service connection for bilateral hearing loss is reopened; to this limited extent, the appeal is granted. New and material evidence having been received, the claim of service connection for tinnitus is reopened; to this limited extent, the appeal is granted. New and material evidence having been received, the claim of service connection for a bilateral foot disorder is reopened; to this limited extent, the appeal is granted. New and material evidence having been received, the claim of service connection for hypertension is reopened; to this limited extent, the appeal is granted. New and material evidence having been received, the claim of service connection for bronchitis is reopened; to this limited extent, the appeal is granted. The appeal as to the issue of service connection for eczema is dismissed as moot. Service connection for high cholesterol is denied. REMANDED Whether new and material evidence has been received to reopen a claim of service connection for a left ankle disorder. Service connection for a bilateral eye disorder. Service connection for bilateral hearing loss. Service connection for tinnitus. Service connection for a bilateral foot disorder. Service connection for hypertension. Service connection for a respiratory disorder, to include bronchitis and chronic obstructive pulmonary disease (COPD). An initial compensable rating for seborrheic dermatitis. FINDINGS OF FACT 1. A March 2010 Board decision denied service connection for a psychiatric disorder, a bilateral eye disorder, bilateral hearing loss, and tinnitus; evidence received since then relates to an unestablished fact and raises a reasonable possibility of substantiating the claims. 2. A December 2013 Board decision denied service connection for a bilateral foot disorder, hypertension, and a respiratory disorder; evidence received since then relates to an unestablished fact and raises a reasonable possibility of substantiating the claims. 3. The Veteran’s schizophrenia is related to service. 4. The Veteran’s high cholesterol is a laboratory finding and not a disability for VA compensation purposes. The Veteran’s service-connected seborrheic dermatitis is rated under the criteria for eczema or dermatitis. CONCLUSIONS OF LAW 1. The March 2010 Board decision that denied service connection for a psychiatric disorder is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1104. 2. New and material evidence having been received, the claim of service connection for a psychiatric disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for service connection for schizophrenia are met. 38 U.S.C. §§ 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The March 2010 Board decision that denied service connection for a bilateral eye disorder is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1104. 5. New and material evidence having been received, the claim of service connection for a bilateral eye disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 6. The March 2010 Board decision that denied service connection for bilateral hearing loss is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1104. 7. New and material evidence having been received, the claim of service connection for bilateral hearing loss is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 8. The March 2010 Board decision that denied service connection for tinnitus is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1104. 9. New and material evidence having been received, the claim of service connection for tinnitus is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 10. The December 2013 Board decision that denied service connection for a bilateral foot disorder is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1104. 11. New and material evidence having been received, the claim of service connection for a bilateral foot disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 12. The December 2013 Board decision that denied service connection for hypertension is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1104. 13. New and material evidence having been received, the claim of service connection for hypertension is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 14. The December 2013 Board decision that denied service connection for a respiratory disorder is final. 38 U.S.C. § 7104; 38 C.F.R. § 20.1104. 15. New and material evidence having been received, the claim of service connection for a respiratory disorder is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 16. The criteria for service connection for high cholesterol are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 17. The appeal with respect to service connection for eczema is dismissed as moot. 38 U.S.C. § 7104. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1982 to April 1988. The case is on appeal from November 2013 and October 2018 rating decisions. The Board notes that the October 2018 rating decision was a readjudication of the earlier November 2013 rating decision that continued prior denials of service connection for a psychiatric disorder, a bilateral eye disorder, bilateral hearing loss, tinnitus, and a left ankle disorder, and assigned an initial noncompensable rating for seborrheic dermatitis. In that respect, following the November 2016 substantive appeal, a February 2017 letter informed the Veteran that the appeal had been placed on the Board’s docket for appellate review. As such, the claims have been pending because the November 2013 rating decision did not become final. Because the February 2013 claims remained pending and the appeal has remained active since that time, and because an appeal was perfected in November 2016, the Board finds that this appeal is properly before the Board and dates from the denial of reopening the service connection claims, as well as with respect to the initial rating assigned for seborrheic dermatitis, in the November 2013 rating decision. Further, while that appeal was pending, the Veteran perfected an appeal with respect to the October 2018 rating decision that denied reopening claims of service connection for a bilateral foot disorder, hypertension, and bronchitis, and denied service connection for high cholesterol, COPD, and eczema. The Board has broadened the service connection issues with respect to bronchitis and COPD to service connection for a respiratory disorder, to include bronchitis and COPD, as reflected above. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The issues of whether new and material evidence has been received to reopen service connection claims for a psychiatric disorder, a bilateral eye disorder, bilateral hearing loss, tinnitus, a bilateral foot disorder, hypertension, and a bronchitis, along with the underlying service connection claim for a psychiatric disorder, as well as the claims of service connection for eczema and high cholesterol, are addressed in the decision below. The issue of whether new and material evidence has been received to reopen a claim of service connection for a left ankle disorder, along with the reopened service connection claims for a bilateral eye disorder, bilateral hearing loss, tinnitus, a bilateral foot disorder, hypertension, and a respiratory disorder, to include bronchitis and COPD, as well as the initial higher rating claim for seborrheic dermatitis, being remanded, are addressed in the remand section. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). 1. Whether new and material evidence has been received to reopen service connection for a psychiatric disorder. 2. Whether new and material evidence has been received to reopen service connection for a bilateral eye disorder. 3. Whether new and material evidence has been received to reopen service connection for bilateral hearing loss. 4. Whether new and material evidence has been received to reopen service connection for tinnitus. In a March 2010 decision, the Board denied service connection for a psychiatric disorder, a bilateral eye disorder, bilateral hearing loss, and tinnitus. That decision is final. 38 U.S.C. § 7104(b); 38 C.F.R. § 20.1100(a). The Board finds that new and material evidence has been submitted so that the previously denied claims of service connection for a psychiatric disorder, a bilateral eye disorder, bilateral hearing loss, and tinnitus, are reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). See also October 2015 VA 21-2680; November 2016 DBQ; November 2016 private record; September 2018 & October 2018 VA treatment records. The underlying service connection claim for a psychiatric disorder is addressed in the decision below. The underlying service connection claims for a bilateral eye disorder, bilateral hearing loss, and tinnitus, are addressed in the remand below. 5. Whether new and material has been received to reopen service connection for a bilateral foot disability. 6. Whether new and material has been received to reopen service connection for hypertension. 7. Whether new and material has been received to reopen service connection for bronchitis. In a December 2013 decision, the Board denied service connection for a bilateral foot disability, hypertension, and a respiratory disorder. That decision is final. 38 U.S.C. § 7104(b); 38 C.F.R. § 20.1100(a). The Board finds that new and material evidence has been submitted so that the previously denied claims of service connection for a bilateral foot disability, hypertension, and bronchitis are reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). See also October 2015 VA 21-2680; November 2016 DBQ; November 2016 private record; September 2018 & October 2018 VA treatment records. The underlying service connection claims for a bilateral foot disability, hypertension, and bronchitis, are addressed in the remand below. 8. Service connection for a psychiatric disorder. The Veteran seeks service connection for a psychiatric disorder. She maintains that her psychiatric symptoms had their onset during service. Lending credibility to the Veteran’s assertion is a November 2016 report in which a private physician stated that the Veteran’s schizophrenia clearly had its onset during service. The Veteran’s STRs were noted to reflect complaints of increased stress and chronic hyperventilatory syndrome, as well as an evaluation in association with ‘a domestic incident.’ See April 2014 & July 2014 STRs. The physician stated that hyperventilatory syndrome is almost always psychologically based, noting symptoms such as feeling nervous, panicky, and anxious, with rapid breathing that deeply lowered the carbon dioxide levels of the blood causing dizziness. Further, in addition to reference to the Veteran’s husband having left the Veteran because he was unable to cope with her illness, the Veteran’s difficulties in school after service due to psychiatric symptoms were noted. The physician concluded that the Veteran’s hyperventilatory syndrome during service was clearly emotionally based and was the initial manifestation of her current schizophrenia. Moreover, a November 2016 report from a private psychologist reflects the Veteran’s history of VA inpatient psychiatric treatment in 1998, as well as an award of disability benefits from the Social Security Administration (SSA) due to a paranoid psychotic disorder. See December 1999 SSA determination. In the field of psychiatry, hyperventilatory syndrome was noted to be referred to as conversion disorder, wherein the psychiatric illness manifests somatically as physical illness. Recent medical literature was noted to reflect that the way in which certain adverse events are processed cognitively can be associated with physical symptoms in conversion disorder. The Veteran’s psychiatric symptoms during service were noted to correlate with emerging mental health difficulties, and the opinion concludes that the Veteran’s schizophrenia is more than likely a result of service. See also March 2017 Correspondence; October 2015 VA 21-2680. The evidence is in favor of the claim, particularly when resolving reasonable doubt in favor of the Veteran. Thus, service connection for schizophrenia is warranted. 9. Service connection for high cholesterol. The Veteran contends that her high cholesterol is related to the nutritional quality of the food she consumed during service. VA treatment records in September 2019 reflect that the Veteran has high cholesterol. However, elevated cholesterol, to include hypercholesterolemia, is considered to be a laboratory result and not a disability for compensation purposes. Sanchez-Benitez v. West, 13 Vet. App. 282 (1999); 61 Fed. Reg. 20,440 (1996) (although Veteran is competent to describe symptoms of pain, pain, alone, without a sufficient factual showing that the pain is derived from the in-service injury is not a disability). Absent evidence of a current disability, a claim for service connection must be denied. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). In the absence of a current disability, the preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Therefore, service connection for high cholesterol is not warranted. Although the Board is remanding a claim for additional development, remand is not necessary for this issue, as there is no reasonable possibility that further assistance would substantiate the claim. See 38 C.F.R. § 3.159(d). 10. Service connection for eczema. The Veteran seeks service connection for eczema; however, the Board finds that service connection has already been granted for the claimed disability. The Veteran is service connected for seborrheic dermatitis. Seborrheic dermatitis is a type of eczema. See https://medlineplus.gov/ency/article/000853.htm. As reflected above, service connection for seborrheic dermatitis was granted in the November 2013 rating decision, and the initial rating was assigned pursuant to the criteria for evaluating eczema or dermatitis. See 38 C.F.R. § 4.118, Diagnostic Code 7806. Accordingly, the Board finds that the benefit sought on appeal has already been granted, and there is no remaining case or controversy pertaining to the Veteran’s claim of service connection for eczema. As such, the appeal with respect to the claim for service connection for eczema is dismissed as moot. See 38 U.S.C. § 7104; 38 C.F.R. § 20.101. The initial higher rating claim for seborrheic dermatitis on appeal is addressed in the remand section below. Although the Board is remanding a claim for additional development, remand is not necessary for this issue, as there is no reasonable possibility that further assistance would substantiate the claim. See 38 C.F.R. § 3.159(d). REASONS FOR REMAND 1. Whether new and material evidence has been received to reopen a claim of service connection for a left ankle disorder. As noted above, the appeal with respect to whether new and material evidence has been received to reopen a claim of service connection for a left ankle disorder is from the November 2013 rating decision. The Veteran has not waived initial Regional Office (RO) consideration of new VA-generated evidence associated with the record since the issuance of the November 2016 statement of the case (SOC), including an October 2015 examination. See October 2015 VA 21-2680. Thus, the Board must remand this matter for issuance of a supplemental statement of the case (SSOC). 38 U.S.C. § 7105(e); 38 C.F.R. § 19.31. 2. Service connection for a bilateral eye disorder. The Veteran seeks service connection for a bilateral eye disorder. She maintains that impaired vision had its onset during service, including as a result of dim lighting in the barracks that caused eye strain. See September 2018 claim. The Board notes that although refractive error was shown at the time of the prior denial, VA treatment records in September 2018 reflect new diagnoses of dry eye syndrome, cataracts, and ptosis, status post repair. In view of the evidence and the Veteran’s assertions, the Board finds the evidence currently meets the low threshold for obtaining a VA examination as to this claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 3. Service connection for bilateral hearing loss. 4. Service connection for tinnitus. The Veteran seeks service connection for hearing loss and tinnitus. Records associated with the file since the prior final denial reflect the Veteran’s reported history of hearing loss and tinnitus since service, and the bilateral sensorineural hearing loss diagnosis meets the criteria for hearing loss under 38 C.F.R. § 3.385. See May 2010 VA treatment records. In addition, VA treatment records in October 2018 reflect hearing aids. In view of the evidence and the Veteran’s assertions, the Board finds the evidence currently meets the low threshold for obtaining a new VA examination as to these claims. See McLendon, 20 Vet. App. at 81. 5. Service connection for a bilateral foot disorder. The Veteran maintains that her current bilateral foot disorder is related to foot symptoms shown in service, including blisters, noting that ill-fitting boots issued caused fallen arches. The Board notes that in addition to the diagnosis of pes planus previously of record, September 2018 VA treatment records reflect arthritis of both feet. Further, October 2018 records reflect a diagnosis of plantar fascial fibromatosis, for which custom orthotics were issued to improve foot pain. In view of the evidence and the Veteran’s assertions, the Board finds the evidence currently meets the low threshold for obtaining a VA examination as to this claim. See McLendon, 20 Vet. App. at 81. 6. Service connection for hypertension. The Veteran maintains that hypertension had its onset during service, to include as a result of stress and the quality of food she consumed during service. See September 2018 claim; December 2013 Correspondence; April 2002 VA 21-4138 Statement in Support of Claim. The Veteran’s STRs reflect elevated blood pressure and increased stress. See April 2014 STRs. In addition, September 2018 VA treatment records reflect prescribed hypertension medication. In view of the evidence and the Veteran’s assertions, the Board finds the evidence currently meets the low threshold for obtaining a VA examination as to this claim. See McLendon, 20 Vet. App. at 81. 7. Service connection for a respiratory disorder. The Veteran maintains that she has a respiratory disorder related to service, including exposure to environmental hazards/air quality during her deployment to Panama. See September 2018 claim. The Veteran’s STRs show upper respiratory infections, as well as allergic rhinitis, sinusitis, and pharyngitis. In addition, and although some respiratory limitation due to obesity was noted at the time of the prior final denial, a respiratory disorder was not diagnosed. See March 2012 VA examination; December 2013 Board decision. However, VA treatment records in September 2018 reflect diagnoses of chronic bronchitis and COPD, and possible fluid in the left lower lobe with bronchial thickening was noted on x-ray examination of the chest. In view of the evidence and the Veteran’s assertions, the Board finds the evidence currently meets the low threshold for obtaining a VA examination as to this claim. See McLendon, 20 Vet. App. at 81. 8. An initial compensable rating for seborrheic dermatitis. The October 2018 VA examination report notes that the Veteran’s skin condition began as a rash on her arms during service, and total body area affected was reported to be 5 percent or less with no involvement of exposed areas, noting no change in the condition. However, the November 2013 VA examination report reflects involvement of the neck and scalp, and both total body area and exposed area affected were 5 percent or less. See also September 2018 VA treatment records. As such, the October 2018 VA opinion is not completely adequate. Thus, a new VA examination is warranted. In view of the remand, VA treatment records since the issuance of the July 2019 statement of the case should be obtained. The matters are REMANDED for the following action: 1. Obtain VA treatment records since July 2019. 2. Issue a SSOC with respect to the issue of whether new and material has been received to reopen a claim of service connection for a left ankle disorder. 3. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of a bilateral eye condition. The claims file must be made available to and reviewed by the clinician. Any indicated studies should be performed, and all findings should be reported in detail. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that a bilateral eye condition had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease. The evidence should be considered, including the Veteran’s statements regarding eye strain during service. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. 4. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of bilateral hearing loss and tinnitus. The claims file must be made available to and reviewed by the clinician. Any indicated studies should be performed, and all findings should be reported in detail. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that hearing loss and/or tinnitus had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease. The evidence should be considered, to include the Veteran’s statements regarding hearing loss and tinnitus during and since service. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. 5. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of a bilateral foot condition. The claims file must be made available to and reviewed by the clinician. Any indicated studies should be performed, and all findings should be reported in detail. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that a bilateral foot disorder had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease. The evidence should be considered, to include the diagnoses of plantar fascial fibromatosis and pes planus, as well as the Veteran’s statements with respect to symptoms during and since service. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. 6. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of hypertension. The claims file must be made available to and reviewed by the clinician. Any indicated studies should be performed, and all findings should be reported in detail. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that hypertension had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease. The evidence should be considered, to include the Veteran’s statements with respect to in-service elevated blood pressure and increased stress. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. 7. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of a respiratory condition. The claims file must be made available to and reviewed by the clinician. Any indicated studies should be performed, and all findings should be reported in detail. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that a respiratory disorder, to include bronchitis and COPD, had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease, to include environmental hazards during service in Panama. The evidence should be considered, to include the Veteran’s statements with respect to in-service respiratory symptoms. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. 8. Schedule the Veteran for an examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) by an appropriate clinician to determine the severity of service-connected seborrheic dermatitis since February 2013. The clinician should address the following: a) Estimate how much of the entire body is affected by the seborrheic dermatitis. b) Estimate how much total exposed area was affected by the seborrheic dermatitis. c) Identify any topical steroidal cream prescribed to treat the seborrheic dermatitis. d) Provide an opinion as to whether the use of any topical steroidal creams constituted systemic therapy. Systemic therapy is defined as a therapy that affects the body as a whole. In answering this question, the method by which the topical treatment works, as well as any known side effects, should be addressed. e) If the Veteran has been prescribed non-steroidal medication for treatment of the seborrheic dermatitis, provide an opinion as to whether those medications are “like” a corticosteroid or other immunosuppressive drug. f) For each topical non-steroidal medication that are “like” a corticosteroid or other immunosuppressive drug, provide an opinion as to whether each constitutes systemic therapy. KANISHA R. LAFFITTE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Taylor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.